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Compare and Contrast Histrionic and Narcissistic Personality Disorder

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Some mental health experts consider HPD and NPD the most similar of the four cluster B personality disorders. Similarities between these conditions may include attention-seeking behavior, flirtatiousness that’s often inappropriate, behavior that seems shallow or uncaring, and a need for approval and admiration from others. Some researchers have even suggested HPD is a manifestation of NPD rather than a unique condition, but the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists HPD as a separate diagnosis

However, it’s possible to have both conditions, or any combination of personality disorders, and this may sometimes complicate diagnosis.

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Personality is the way of thinking, feeling and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A person’s personality typically stays the same over time. A personality disorder is a way of thinking, feeling and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time

There are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning. Without treatment, personality disorders can be long-lasting. Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. Diagnosis is typically made in individuals 18 or older. People under 18 are typically not diagnosed with personality disorders because their personalities are still developing. Some people with personality disorders may not recognize a problem. Also, people may have more than one personality disorder. An estimated 9 percent of U.S. adults have at least one personality disorder. Certain types of psychotherapy are effective for treating personality disorders. During psychotherapy, an individual can gain insight and knowledge about the disorder and what is contributing to symptoms, and can talk about thoughts, feelings and behaviors. Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships. The type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s circumstances. There are no medications specifically to treat personality disorders. However, medication, such as antidepressants, anti-anxiety medication or mood stabilizing medication, may be helpful in treating some symptoms. More severe or long lasting symptoms may require a team approach involving a primary care doctor, a psychiatrist, a psychologist, social worker and family members.

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No standardized pharmacological or psychological treatment has been established for persons with narcissistic personality disorder.[10] More often than not, NPD is present, along with other mood disorders. Once a diagnosis is established, it is essential to discuss the diagnosis because of several challenges that mostly will be present in the future (Dieckmann E, Behary W., 2015). It is equally important to treat ongoing symptoms of co-occurring affective disorders. Kohut and Kernberg have focused on long term therapy and exploring the relationship between a therapist and patient, which continues to be established treatment for persons with a narcissistic personality disorder.Psychodynamic psychotherapy focuses on defenses present during therapy sessions

Many therapists have advocated for ongoing therapy for patients with an established diagnosis of NPD. NPD may significantly reduce emergency department visits and lower the incidence of self-harm. Of note, studies are more focused on borderline personality disorder; however, borderline personality disorder's findings may be generalizable to other disorders as well. Transference focused therapy is structured twice a week psychoanalytic therapy that focuses on personal expression of emotions toward a therapist. Given that persons with NPD can often be provoked by their perception of being treated by another, their own emotions towards other people are essential. Schema focused therapy is relatively new and focuses on alternate forms of cognitive-behavioral therapy, including activating emotional senses. There are no FDA approved medications for the treatment of NPD, but many patients may benefit from treatment of symptoms, including anxiety, depression, mood lability, transient psychosis, and impulse control issues. Antidepressants, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, have been used (Kernberg OF., 2014).

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Overall, the treatment produced significant changes in these behaviors both statistically and qualitatively. Empirical methods for analyzing the changes across sessions and for determining that the therapist engaged in the proposed mechanism of clinical change are discussed. While these data are for one subject, the results of treatment provide both a method of treating difficult and long-standing client behaviors such as these, and for assessing the progress of therapy.

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Kernberg OF. An overview of the treatment of severe narcissistic pathology. Int J Psychoanal. 2014 Oct;95(5):865-88.

Gabbard GO. Psychotherapy of personality disorders. J Psychother Pract Res. 2000 Winter;9(1):1-6.

Caligor E, Levy KN, Yeomans FE. Narcissistic personality disorder: diagnostic and clinical challenges. Am J Psychiatry. 2015 May;172(5):415-22.

Dieckmann E, Behary W. [Schema Therapy: An Approach for Treating Narcissistic Personality Disorder]. Fortschr Neurol Psychiatr. 2015 Aug;83(8):463-77; quiz 478.

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